Hanover Valley Presbyterian Church
2026 Consent and Liability Statement
Medical Treatment Authorization The undersigned parent/guardian hereby authorizes any responsible adult bearing this written authorization , into whose care the mentioned child may require an X-ray, examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care, to be rendered to said minor under the general or special supervision and upon the advice of a licensed physician and/or surgeon and to consent to an X-ray, examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to said minor by a licensed dentist. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required.
Liability and Release Agreement In consideration of the child’s participation in ministries and activities, as well as transportation to and from ministries and activities of Hanover Valley Presbyterian Church , I agree to release, indemnify, defend, and forever discharge the Church, the session, employees, staff, and volunteers from any and all claims, losses, or injuries (up to and including death). I/We certify that the child named is physically and medically able to participate. In the event of an emergency, every effort will be made to contact the parent/guardian. If unreachable, I/We give permission to the physician selected by the Church to hospitalize and secure treatment for the child as the physician sees fit.
Media and General Policies Appropriate photographs and/or video recordings may be taken of the child and published in Church materials such as bulletin boards, flyers, and the website. I/We give permission for such use and release the Church from any claims resulting from such publications. Unless otherwise directed, I authorize the Church to release my child to his/her own authority at the conclusion of the activity. This authorization is effective immediately and will remain in effect for a time limit not to exceed 12 months.